Shingles in young adults is a uniquely challenging condition. All adult shingles outbreaks are caused by the very same varicella-zoster virus that causes the chickenpox in children. Shingles arise when that same virus reactivates, usually after years of dormancy in people who’ve had chickenpox (and who are therefore immune). Shingles is normally associated with people over age 50. The shingles rash, often in a band around the torso, mainly causes irritation. Sometimes, however, the pain can be excruciating, caused when the virus irritates the sensory nerves where the inflammation erupts. In fact, the pain can persist for some time after the rash itself has healed.

In the years since 1998, when the varicella vaccine was introduced in Canada, the incidence of chickenpox has fallen by 82%. In the years since the chickenpox vaccinations, however, shingles has become more common in young adults in their 20s and 30s. As a result, we’re fielding more questions about shingles in young adults and how to prevent outbreaks.

Only people who’ve had chickenpox can contract shingles. Prior to the advent of the vaccine, more people got chickenpox—which also meant more people were also repeatedly exposed to the virus after their own recovery from (and immunity to) chickenpox. This pattern of re-exposure served to boost the immunity of those adults who had chickenpox pre-vaccine. Unfortunately, a side effect of the varicella vaccine’s extreme efficacy and wide proliferation is that, because children are far less likely to contract chickenpox, the adults around them may not be re-exposed to the varicella virus.

Some scientists suggest that this lack of community exposure explains why more young adults are presenting with shingles. Another school of thought looks at the same trend, but it tracks the data spike to the advent of a new, easier test as the driver of both increased early diagnosis and reporting. Chances are higher for shingles at a younger age, it seems, when stress is high—it’s a known trigger for many skin, nail, and hair ailments. Having other family members who’ve had chickenpox seems to reduce the risk for early shingles outbreak, perhaps thanks to re-exposure. Nonetheless, shingles is not just a geriatric problem anymore. Thankfully, shingles in young adults generally isn’t as severe or long lasting as in the elderly.